Association between Experiences of Different Types of Harassment or Derogatory Treatment and Sexual Harassment among Employees at a Large Swedish University

Sexual harassment (SH) and other forms of mistreatment continue to be a significant problem at workplaces, leading to negative health and work-related outcomes. Previous studies have mainly examined SH and other types of workplace harassment separately. In this study we investigated whether harassment related to any of the seven Swedish legal grounds for discrimination (sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation, or age) and derogatory treatment were associated with SH at a large Swedish university. Using cross-sectional survey data obtained from 33% of all staff, multivariable logistic regression analysis was performed to investigate associations between harassment, derogatory treatment, and SH. We found a sixfold increased risk of SH among women with experience of other forms of harassment and a three-times-higher risk among women with experience of derogatory treatment, indicating that SH co-occurs with other forms of mistreatment. This pattern was similar among men, although men reported lower prevalence of mistreatment. Our findings have implications for preventive strategies at academic workplaces indicating that issues related to the defence of power and various types of abusive behaviours, including SH, both need to be addressed to create more equal opportunities for all employees.


Introduction
Sexual harassment (SH) continues to be a significant problem at many workplaces, even though the general awareness of the problem increased after the #metoo movement in 2017 [1]. Other forms of mistreatment also exist at workplaces and share some features in common with SH [2]. As previous studies have mainly examined SH and other types of workplace harassment separately, research gaps exist concerning the relationship between various types of harassment, including SH [3]. In this study we investigated whether experiences of other types of harassment, defined as behaviours associated with one of the seven Swedish legal grounds for discrimination: sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation, or age, and derogatory treatment, defined as insulting acts such as withholding information, derogatory comments, or exclusion, were associated with SH at a large Swedish university. The overarching term for all three types of undesirable behaviours (harassment, derogatory treatment, and SH) that we use in this paper is workplace mistreatment.
SH leads to multiple negative health-and work-related outcomes [3][4][5]. Individual and job-related consequences reported include anxiety, depression, decreased job satisfaction, absenteeism, and reduced productivity, not only affecting the individual but also causing considerable costs for organisations [6][7][8][9]. Negative consequences can be seen even in relatively mild cases of SH, such as sexist put-downs or offensive sexual remarks [10,11].
Sweden SH is mainly treated as a form of discrimination and falls under the Discrimination Act, defined as a conduct of a sexual nature that violates a person's dignity [30]. SH can also constitute criminal acts, such as unlawful invasion of privacy or sexual molestation and is then regulated in the Swedish Penal Code. Other types of harassment, defined as situations when a person's dignity is violated, must be related to one of the seven legal grounds for discrimination, i.e., "sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation, or age" to fall under the Discrimination Act. Harassment or SH are behaviours that are unwelcome, and it is the victim of harassment who determines what is unwelcome or offensive. This means that there are no specific behaviours that define harassment or SH mentioned in the Discrimination Act, but rather it is the victim's perception of a behaviour that is of importance. The perpetrator, however, must understand that the behaviour is unwelcome for it to be classified as harassment or SH according to the law [31].
Another form of mistreatment at the workplace regulated in Swedish law is defined as offensive or abusive actions towards one or more employees that may lead to ill health or to exclusion from the workplace community [32]. In this study we refer to this phenomenon as derogatory treatment, which includes experiences of insulting acts such as withholding information, derogatory comments, or exclusion. Swedish employers are obliged to pursue active prevention work against SH, harassment, and derogatory treatment at the workplace. However, undesirable behaviours continue to be a problem at Swedish workplaces and preventive measures need to be improved [33][34][35][36][37].
In summary, SH and various kinds of mistreatment exist at workplaces today with negative health-and job-related impacts on individuals and organisations. SH at the workplace seems to overlap with other forms of workplace mistreatment, and a better understanding of how these are related would be valuable when designing preventive measures. Workplace mistreatment is often rooted in hierarchical power relations. As the academic workplace is often characterised by formal and informal power relations, SH and other forms of mistreatment among the staff in this setting are of particular interest. Hence, the aim of this study was to examine whether experience of different forms of harassment and derogatory treatment was associated with SH among employees at a large public university in Sweden. Furthermore, a secondary aim was to investigate whether such associations differ by gender.

Data Collection
This study is part of the project "Tellus", initiated at Lund University (LU), Sweden, 2018, with the aim of reinforcing preventive work against SH at the university [38]. As part of the Tellus project, a cross-sectional survey targeting both staff/PhD students and students was conducted at LU in 2019. The survey included questions related to SH, but also harassment related to the seven Swedish legal grounds for discrimination (sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation or age) and derogatory treatment. Questions about the gender of the perpetrator and the relationship between the victim and the perpetrator were also included. The survey instrument used, as well as the overall results, such as prevalence of SH while employed at LU, are presented in detail elsewhere [39].

Study Population
In November 2019 a survey in both English and Swedish was sent by email to all staff at LU. PhD students are primarily employed by the university in Sweden and were therefore included as staff in our survey. The response rate was 33% (N = 2750). After exclusion of those with missing data on both sex and gender, those who did not answer any of the 10 questions on experiences of SH or those who did not specify when the SH took place, the final study population consisted of 2732 staff/PhD students.
A comparison between the participants and the target population by means of employment records found no major differences. However, a few observations were made; women were slightly over-represented among study participants and both men and women participants tended to be somewhat older compared to the target group. Further, a slight over-representation of staff with permanent employment (versus temporary) was seen [39].

Outcome Variable: Sexual Harassment and Sexual Violence
As the outcome variable, we used experiences of SH during the past 12 months at LU. The variable was based on the following list of ten behaviours, including one behaviour representing sexual violence, to measure experiences of sexual harassment or sexual violence: unwelcome suggestive looks or gestures; unwelcome soliciting or pressuring for 'dates'; unwelcome 'inadvertent' brushing or touching; unwelcome bodily contact such as grabbing or fondling; unwelcome gifts; unwelcome comments; unwelcome contact by post or telephone; unwelcome contact online, for example, by social media or email; stalking; and attempts to conduct or the conduct of oral, vaginal, or anal sex or other equivalent sexual activity in which one did not participate voluntarily [39]. The study participants were asked if they had experienced any of these behaviours in connection with their employment at LU with the answer options: Yes, once; Yes, more than once; and No. All participants who answered yes to at least one of the above behaviours and stated that the behaviour/s occurred during the past 12 months were classified as exposed to SH during the past 12 months at LU.

Harassment
The following text introduced the section about harassment in the survey: "The simplified definition of harassment provided in the Discrimination Act is that harassment occurs when someone is subjected to an act that violates their dignity and that this violation is associated with one of the seven grounds for discrimination: sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation or age. Harassment can be both individual and isolated events as well as subtle, almost imperceptible events that continue over time, so-called microaggressions. It can also be a process that is ongoing and permeates the entire working life." The participants were asked if they had experienced harassment as described above in connection with their work at LU during the past 12 months. The answer options were: No; Yes, once; Yes, more than once; and Yes, in the form of microaggressions or ongoing process. It was possible to select more than one answer to indicate whether the harassment was in the form of isolated acts, microaggressions or both. All participants answering Yes, once, Yes, more than once, or Yes, in the form of microaggressions or a process that is ongoing, were categorised as exposed to harassment and all others as not exposed. To obtain information about the type of harassment that was experienced, the participant was asked to select, from a list of the seven legal grounds for discrimination, the particular grounds to which the harassment could be attributed. It was possible to select several grounds.
The Swedish language uses the same word for both sex and gender. The official translation in the Discrimination Act is "sex". Unless directly citing the Discrimination Act, we use "gender" in the subsequent sections of this paper.

Derogatory Treatment
In the survey, the following information introduced the section with questions related to derogatory treatment: "This refers to derogatory or insulting acts directed at one or more employees. Examples of such acts include withholding information, derogatory comments and exclusion. The Swedish Work Environment Authority includes other examples such as the use of derogatory nicknames, shutting out, exclusion from meetings, unfair accusations, public personal attacks, and referring to someone in offensive terms in front of others. "The question was then put: Have you experienced derogatory treatment in conjunction with your work at Lund University during the past 12 months?" The answer options were: No; Yes, once; and Yes, more than once. All participants answering Yes, once or Yes, more than once were classified as exposed to derogatory treatment and all others as not exposed.

Multiple Forms of Harassment or Derogatory Treatment
Each study participant could report experiences of several forms of harassment associated with the legal grounds for discrimination (sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation, or age) as well as derogatory treatment. To explore experiences of multiple forms of harassment or derogatory treatment, we created a new variable summarising all forms reported by each individual, including experiences of derogatory treatment, and thereafter categorised all participants into three categories: Not exposed to any form of harassment or derogatory treatment; Exposed to one form of harassment or derogatory treatment; and Exposed to two or more forms of harassment or derogatory treatment. One participant had reported experiences of harassment once and two other participants had reported experiences of microaggressions but not linked to any specific form of harassment. These three participants were classified as exposed to one form of harassment or derogatory treatment.

Sexual Harassment/Violence outside the University Setting
Survey participants were asked in two separate questions if they ever had been subjected to sexual harassment and/or sexual violence outside LU with the answer options: Yes, once; Yes, more than once; and No. All participants answering Yes, once or Yes, more than once to at least one of the two questions were categorised as exposed to SH/sexual violence outside LU and all others as not exposed.

Background Variables
Gender: Gender was based on two gender-related questions in the survey: 'What gender were you assigned at birth?' (female/male) and 'what is your current gender identity?' (Female/male/I do not identify as male or female). The answer to the second question was used to define participants as woman, man or non-binary; however, when the answer to this question was missing (N = 15), the answer to the first one was applied.
Form of employment: Participants were asked whether their form of employment was permanent or temporary.
Professional position: Professional position was specified according to nine types in the survey: "professor", "senior lecturer", "lecturer/teaching assistant", "postdoc/associate senior lecturer", "researcher/associate researcher", "PhD student/research student", "administrative staff/library staff", "technical staff", and "other". For the purpose of analyses, some categories were grouped together. This resulted in the following six categories used in our analysis: "professors", "senior lecturer", "lecturer and researcher", "PhD students", "administrative and technical support staff", and "others".
Foreign background: Participants who were either born abroad or had two parents born abroad were categorised as individuals with a foreign background, in line with the definition used by Statistics Sweden [40]. Participants lacking information about parents' country of birth were presumed to have Swedish background if they were born in Sweden.

Gender, Function and Formal or Informal Power Relation of Perpetrators
Participants who reported experiences of harassment and derogatory treatment, respectively, were asked about the gender of the perpetrator/perpetrators (male, female, non-binary or don't know) as well as their function (a person employed at LU, a PhD student/research student at LU, a student at LU, or/and another person that I met through my work at LU) and the power relation between the perpetrator and the participant. If the perpetrator was a university employee, the following options were offered: (1) a person upon whom I was reliant; (2) a person in position of formal seniority to me; (3) a person in a position of power (formal or informal) over me; (4) a person over whom I am/was in a position of (formal or informal) power; and (5) another person at Lund university. The alternatives (1), (2), and (3) were categorised together as "dominant/upper position" in the analyses, indicating that the perpetrator had a dominant or higher power position in relation to the victim. If the perpetrator was a PhD student, the above-described alternatives (3), (4), and (5) were offered and categorised as representing a perpetrator's "dominant/upper position", "dependent/lower position" or "another person/relationship", respectively, in relation to the victim in the analysis. As a participant could have been subjected to harassment and derogatory treatment by several perpetrators, it was possible to mark several options regarding gender, function and power relation.
The same follow-up questions were asked about perpetrators of SH. However, as the questions about perpetrators referred to all experiences of SH, irrespective of time, we could not separate the information pertaining to perpetrators of SH during the last 12 months. However, the results regarding gender, function and power relation of perpetrators of SH (SH at any time) are published in a previous study presenting the overall results of the "Tellus" project [39].
The question regarding the gender of the perpetrator was not put to the participants who reported that they had been exposed to harassment in the form of microaggressions only (81 participants). Therefore, those 81 participants were excluded from the total number of participants exposed to harassment in the top section of Table 3 showing the gender of perpetrators.

Statistical Analysis
We used descriptive statistics to analyse the sociodemographic characteristics of the sample, prevalence of SH, harassment and derogatory treatment, as well as gender, professional position and power relation of the perpetrators of harassment and derogatory treatment.
Association between background variables and SH was explored through a bivariate logistic regression analysis. A multivariable logistic regression analysis, including three different models adjusting for stepwise added background variables (age, foreign background and professional position) was performed to investigate associations between harassment, derogatory treatment or previous experience of SH outside LU and the outcome of SH. Interaction analyses were performed with dummy variables combining gender with exposure to harassment and gender with exposure to derogatory treatment, using men not exposed to harassment or derogatory treatment as the reference. When data allowed (not possible for all types of harassment due to small numbers), interaction analyses were performed by combining gender with specific types of harassment. The synergy indexes were calculated as proposed by Rothman, whereby a synergy index >1 indicates a synergistic effect, and a synergy index <1 an antagonistic effect [41].
We thought it important to present data from non-binary participants in the descriptive statistics, as this is rarely carried out due to often small numbers. By including them we make our data available for future pooled studies. However, due to small numbers, we excluded non-binary participants (24 out of 2732) from further analysis.
Statistical analyses were performed in Stata version 13.

Ethics
The data collection and use were approved by the Regional Ethical Review Board in Lund (Dnr 2018/350) and was in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Results
In total, 2732 individuals participated in the study, of which 57% were women, 42% men and 1% of non-binary gender. Generally, the men had higher professional positions than the women; 17% of the men versus 5% of the women reported that they were professors, and almost half of the women categorised themselves as administrative and technical staff compared to less than a third of the men. Regarding background factors, no other major differences were found between women and men. Table 1 shows the sociodemographic characteristics of the sample separately by gender.

Prevalence of SH, Harassment and Derogatory Treatment
Of all women, 8% reported having experienced SH at Lund University during the last 12 months compared to 3% of all men ( Table 2). The three most common SH behaviours reported among both women and men were, in descending order, unwelcome comments, unwelcome suggestive looks or gestures, and unwelcome contact online; for example, by social media or email. Stalking was reported by six women and two men and attempted or completed rape by two women and no men.
Harassment related to any one of the seven Swedish legal grounds for discrimination (gender, transgender identity, sexual orientation, age, disability, religion and ethnicity) was reported by 10% and 4% of the women and men, respectively (Table 2). Harassment was more commonly reported as isolated events compared to microaggressions, except in the non-binary group ( Table 2). The most common grounds for harassment in all groups were gender and age ( Table 2). As many as 19% of the women and 9% of the men reported experience of derogatory treatment. Regarding single or multiple forms of harassment or derogatory treatment, 15% of all women reported experience of one form of harassment or derogatory treatment and 7% reported two or more forms. The equivalent numbers among men were 8% and 3%, respectively.
A vast majority of all women (61%) had previous experience of SH or sexual violence outside the university setting, not limiting the time window to the past 12 months. The corresponding number among men was 16% ( Table 2).
The highest prevalence of experience of SH, harassment associated with the seven grounds for discrimination, and derogatory treatment was found in the non-binary gender group (Table 2).

Gender, Professional Function and Power Relation of the Perpetrator
The perpetrator of harassment or derogatory treatment was most often a man, irrespective of the gender of the exposed person. Of all participants exposed to harassment, 75% had been exposed by a man and 42% by a woman (it was possible to mark several options). Corresponding figures concerning derogatory treatment showed that 64% of the participants reporting experiences of derogatory treatment had been exposed by a man and 48% by a woman (see Tables 3 and 4. Further, the perpetrator of harassment and derogatory treatment was most often another university employee with a dominant/higher position in relation to the victim. A total of 64% of the participants with experiences of harassment reported that the perpetrator was another university employee with a dominant/higher position in relation to them ( Table 3). The corresponding figure for participants with experiences of derogatory treatment was 76% (Table 4). Table 3. Gender, function and power relation of the perpetrator/perpetrators * of harassment associated with the Swedish legal grounds for discrimination, by gender of exposed person.

Gender of Participants Exposed to Harassment ** Women (90)
Men (  Note: * Exposed persons could mark several options; ** information on gender of the perpetrator was missing for all participants reporting experiences of harassment in the form of microaggressions only (81 participants), and therefore they were excluded from the total number of exposed in the gender of perpetrator section. For more information, see Methods. The percentages are given as the percentages of 'yes' answers out of the total number of exposed persons in each gender group. The harassment took place during the last 12 months at Lund University. Table 4. Gender, function and power relation of the perpetrator/perpetrators * of derogatory treatment by gender of exposed person.

Gender of Participants Exposed to Derogatory Treatment Women (290)
Men (108) Non-Binary ( Note: * Exposed persons could mark several options; the percentages are given as percentages of 'yes' answers out of the total number of exposed persons in each gender group. The derogatory treatment took place during the last 12 months at Lund University. Table 5 presents the associations between background variables, as well as exposure to other forms of harassment or derogatory treatment, and the outcome variable SH during the last 12 months at LU, separately by gender. Among women, a twofold risk of SH was found in the youngest age group (30 years and younger) compared to the oldest age group (60 years and above) (OR 2.4 95% CI 1.1-5.3). This pattern was not seen among men. No significant association was seen between professional position, form of employment or background (Swedish or foreign) and SH. Among both women and men, significant associations were found between experience of other forms of harassment or derogatory treatment and SH, as well as between experience of SH/sexual violence outside the university setting and SH at LU (Table 5). Note: * Harassment associated with the Swedish legal grounds for discrimination; ** summarising experiences of different types of harassment linked to the legal grounds for discrimination and derogatory treatment; CI, confidence interval; OR, odds ratio; SH, sexual harassment. All harassment and SH took place at LU during the last 12 months if not otherwise stated.

Association between Harassment, Derogatory Treatment and SH
The multivariable logistic regression analysis showed a sixfold-increased risk of experiencing SH among women who had experienced harassment associated with any of the seven legal grounds for discrimination (Table 6). This elevated risk remained after adjusting for age, foreign background and professional position in Model 3 (OR 6.1 95% CI 3.9-9.4). The risk of experiencing SH among those who reported derogatory treatment was three times as high (OR 3.2 95% CI 2.1-4.7), and the risk of experiencing SH among those who had reported multiple forms of harassment or derogatory treatment (two or more forms of harassment associated with the seven legal grounds for discrimination or derogatory treatment) was eight times higher after adjusting for age, background (foreign or Swedish) and professional position (OR 7.5 95% CI 4.5-12.5). The pattern was similar among men, although with larger confidence intervals due to smaller numbers. Table 6. Association between exposure to harassment *, derogatory treatment, experience of SH/sexual violence outside of Lund University and sexual harassment at Lund University, by gender. Odds ratios and 95% confidence intervals presented for three different multivariable logistic regression models. Women n = 1546, Men n = 1158. Note: a: Model 1: crude; b: Model 2: adjusted for age and background (foreign or Swedish); c: Model 3: adjusted for age, background (foreign or Swedish) and professional position; * harassment associated with the Swedish legal grounds for discrimination; ** summarising experiences of different types of harassment linked to the legal grounds for discrimination and derogatory treatment; CI, confidence interval; OR, odds ratio; SH, sexual harassment. All harassment and SH took place at LU during the last 12 months if not otherwise stated.
A clear association was also found between previous experience of SH/sexual violence outside the university setting (time not specified) and SH during the last 12 months at LU, among both women and men, with a doubled risk among women (OR 2.3 95% CI 1.4-3.6) and three times as high risk among men (OR 2.8 95% CI 1.3-5.9) after adjusting for age, background (foreign or Swedish) and professional position (Table 6).

Interaction Analysis
Interaction analyses performed with a dummy variable combining gender with exposure to harassment, and using men not exposed to harassment as the reference, indicated a moderate synergistic effect (SI 1.53) of female gender on the association between harassment and the outcome SH (Table 7). A similar analysis was performed by combining gender with exposure to derogatory treatment, showing no synergistic effect on SH (Table 7). Further interaction analyses were performed by combining gender with different types of harassment (only possible for age, gender and disability due to small numbers) regarding the effect on SH, but no modifying effects were found.

Discussion
This study investigated the association between experience of different types of harassment or derogatory treatment and SH among employees at a large Swedish university. We found a three-times-higher risk of SH among women with experience of derogatory treatment and a sixfold-increased risk of SH among women with experience of harassment, where such harassment was mainly attributed to gender and age. The highest risk of experiencing SH among women (eight times higher risk) was found among those who had reported multiple forms of harassment or derogatory treatment. The increased risks remained statistically significant after adjusting for age, foreign background and professional position. A similar pattern was seen among men, although men reported lower prevalence of mistreatment in general. Further, we found a moderate synergistic effect of female gender on the association between harassment and the outcome of SH, indicating that women with experiences of harassment had a higher risk than men with the same experience of also experiencing SH. The non-binary individuals were not included in the above-mentioned analysis because of low statistical power, but they reported the highest prevalence of SH, harassment and derogatory treatment.
Our results indicate that experiences of SH co-occur with other forms of mistreatment. This is in line with results from a study by Lim and Cortina finding an association and co-occurrence between sexual harassment and general incivility [29], as well as other research showing that individuals often report experiences of multiple forms of harassment and discriminatory behaviours at the workplace [21]. Our results also indicate that power relations play a role in situations of harassment and derogatory treatment, as most of the victims reported that the perpetrators were in a dominant/higher position in relation to themselves. Similarly, previous results from the same survey showed that perpetrators of SH were in a dominant/higher position in relation to the victim [39]. This result supports the theory that SH and other types of harassment may be driven by the need to defend or reinforce one's power position [2,3]. We do not presuppose any causal direction between SH and other harassment or derogatory treatment. It is plausible that the defence of a social status or power position might involve a variety of behaviours directed towards the victim, thus generating experiences of multiple forms of mistreatment among the affected. The behaviours might vary as well as the perceptions of such behaviours, where victims' perceptions might vary depending on previous experiences, social status or gender. For example, Berdahl and Aquino found a large gender difference regarding experiences of sexual behaviour at work; 46% of the men reported that they enjoyed it, compared to 10% of the women [42]. Other researchers have identified individual factors, such as age, gender, gender role, past experiences of sexual harassment and perceptions of management's tolerance of sexual harassment, to be related to attitudes toward sexual harassment [43].
In this light, the identification of SH at the workplace can be an indicator of a larger problem, i.e., the existence of an unequal organisational culture where multiple types of abusive behaviours rooted in power imbalance and the defence of power contribute to unequal opportunities among employees. Our results have implications for designing preventive measures, suggesting that issues related to the defence of power and the various types of abusive behaviours including SH at a workplace both need to be addressed. On the other hand, it is possible that a positive spill-over effect could occur concerning other types of harassment behaviours if actions targeting SH behaviours are successful, given that the defence of power can be manifested in various ways by one individual.
In the university setting, there are various formal and informal hierarchical power relations that might trigger the defence of power irrespective of gender. However, underlying all other forms of power relations between staff is the informal and formal power imbalance between men and women. Men are generally attributed with higher status compared to the women in organisations, which gives men more informal and formal power [44]. Moreover, a formal power imbalance is evident in that men dominate the higher positions in the Swedish academic sector [45], which is also the case at Lund University, where, for example 72% of the professors were men in 2019 (personal communication human resources at LU) [45]. This power imbalance between genders is the context within which our study results should be understood. A majority of the perpetrators of harassment and derogatory treatment in our study were men, and data from the same survey shows that this also applies to perpetrators of SH [39]. The victims, on the other hand, were more often women; experiences of SH, harassment and derogatory treatment were about twice as common among women compared to men in our study. The formal and informal power imbalance between female and male university staff and its consequences should be systematically examined. Efforts to target and reduce workplace mistreatment at the academic workplace might mitigate the negative effects of gender inequality, although a true power balance is required to achieve real gender equality at academic workplaces.

Strengths and Limitations of the Study
Our study has a large scope, including experiences of SH as well as other forms of harassment and derogatory treatment, which is a major strength. Studies examining SH together with other types of mistreatment are, to our knowledge, few, and thus the current study might contribute new valuable knowledge to the field of SH research. We base our analysis on a cross-sectional survey sent by email to all staff, which included PhD students and administrative staff at LU. The response rate was 33%, which might be considered low, but a comparison between the participants and the target population showed no major differences, and we believe our data represents the target population well. A limitation of questionnaire surveys concerning sensitive topics is that people with relevant experiences may choose not to participate because they do not want to be reminded of uncomfortable events. This might lead to an under-representation of those exposed. However, the opposite might also be true: people with no such experience might think that the survey is not relevant to them, causing an under-representation of those not exposed. We were able to control for the potential confounding effect of age, foreign background, and professional position in the analysis, which is an important strength in our study. This study is based on self-reported experiences of unwanted behaviours defined as SH, harassment, and derogatory treatment, which might be different from the number of cases meeting the legal definitions of SH and harassment. However, previous findings show that perceptions of SH and other types of workplace mistreatment are linked to ill health, and therefore self-reported experiences are relevant to our study [17,19]. In our study, we define SH using a list of ten unwanted behaviours. Generally, a definition of SH using a list of behaviours yields higher prevalence rates compared to using only one question [46]. Information about experiences of harassment and derogatory treatment, on the other hand, was obtained using one question, respectively. We introduced the questions related to harassment and derogatory treatment with explanatory texts, which for derogatory treatment also included examples of such behaviours. However, it is possible that if we had instead defined harassment and derogatory treatment using a list of behaviours it would have generated higher prevalence levels affecting the associations found between SH, harassment and derogatory treatment. A limitation of this study was that, due to low numbers, it was not meaningful to perform more detailed analysis of the non-binary gender group or specific harassment forms (sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation or age). Further, as our study results are based on cross-sectional data, it is not possible to draw conclusions on the direction of causality.

Conclusions
In this study we found an increased risk of having experienced SH among those who also reported experiences of harassment or derogatory treatment, which indicates that experiences of SH co-occur with other forms of mistreatment. We also found that the prevalence of various types of mistreatment at the workplace is higher among women compared to men. Further, our results indicate that power plays a role in situations of harassment and derogatory treatment, supporting the theory that the defence of power may be a motivating factor underlying various types of harassment, including SH. Our findings might have implications for designing preventive strategies at academic workplaces, suggesting both the need to address issues related to the defence of power as well as measures to counteract various types of abusive behaviours, including SH. This knowledge can be useful when improving preventive measures to counteract workplace mistreatment, contributing to more equal opportunities for all at workplaces.  Institutional Review Board Statement: The data collection and use were approved by the Regional Ethical Review Board in Lund (Dnr 2018/350) and was in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In the survey's cover letter, participants were informed that participation was voluntary, that data would remain confidential and anonymous, and that no individual persons would be recognisable from any studies related to the survey.
Informed Consent Statement: Informed consent was obtained from all individual participants included in the study. In the e-mail survey's cover letter, participants were informed that participation was voluntary, and that data would remain confidential and anonymous. No individual persons would be recognizable from any studies related to the survey.